Objective To study the HLA match rate of 222 living-related donors for kidney transplantation, and to give suggestions for clinical selection of suitable donors and recipients. Methods We analyzed the HLA match rate of 222 kidney transplantations from living relative donors from April 2006 to December 2008. There were 168 male recipients and 54 female recipients. The ages of 222 recipients ranged from 10 to 58. There were 133 male donors and 89 female donors. The ages of 222 recipients ranged from 21 to 64.Results The HLA-A, B, DR, DR, antigens of 87 kidney transplantations from living parental donors were half-matched, of which 14 were higher than half-matched. The HLA-A, B, DR, DQ antigens of 7 kidney transplantations from living children donors were half-matched, including 2 cases higher than half-matched.Among 56 kidney transplantations from living sibling donors, 12 cases were totally mated, 34 cases were half-matched, and the rest were less than half-matched or mismatched. Among 72 kidney transplantations from other living relative donors, 20 cases were higher than half-matched and 5 cases were completely mismatched. More than 4 HLA antigens in 6 cases were matched, but not half-matched. Three HLA antigens or less were matched in 41 cases. Conclusion The HLA match rates from living parental, children, or sibling donors were higher than other relative donors.

Humanization is becoming increasingly significant inpatient-nurse collaboration. In China,the bed-nurse ratio is unbalanced,the medical dispute is serious and the patient′s satisfaction is not high.Narrative medicine which exertnalizing one′s experiences and emotion,are beneficial to patients′physical and mental rehabilitation. In narrative nursing, nurses entered into patients′ feeling and feel empathy,then provided higher quality nursing care.Narrative nursing effectively makes up for the lack of humanistic care. This article shows the development and shorts of humanistic care. Then discussed the practical application and limitations of narrative nursing as well as it′s significance of strengthening humanistic care.

Objective To learn the true experiences of clinical nursing leaders like the head of nursing department and head nurses of a hospital in their implementation and management of narrative care for reference in effective implementation. Methods This study used purposive sampling and snowball sampling of phenomenological research methods. 13 nursing managers were selected from 3 tertiary hospitals in Jiangsu and Hebei province for a semi-structure interview. The interview focused on implementation of such care. Results Following four themes emerged from original interview materials. Namely, the team building experience of narrative care (led by the hospital leader, the establishment of the nursing psychology committee, and the formation of the department narrative nursing team), nurse training of narrative care (phased training, test of learning effects, and qualifications of psychological counselors ), practical management of narrative care (encouragement first, and pressure as auxiliary means), and evaluation of nursing managers on the narrative care (active role, difficulties in implementation). Conclusions As an effective way of psychological nursing care, narrative nursing deserves nationwide application. Success of the application depends on emphasis and support of nursing managers who are expected to pay high attention and promote narrative nursing with teamwork power, so as to develop the narrative care ability of nurses.

Objective To explore the main factors of the medical communication between physicians and nurses in gynecological emergency treatments. To evaluate the function of SBAR communication mode in enhancing communication skills and to explore the countermeasures of promotion. Methods Totally 18 gynecological physicians and nurses were selected as the subjects in this study,and semi-structured interviews were conducted. After the establishment of coding and archiving system, the collected information was extracted and analyzed. Results The factors that affect gynecologic emergency medical staff effective communication included assessment of the patients′ condition, the limitation of communication conditions,the different concerns between doctors and nurses,the differences of medical communication training degree,seniority,experience and knowledge reserve,the medical team consciousness. Conclusion The effective communication of gynecologic emergency care can be promoted by improving professional levels of medical care personnel,strengthening the cultivation of the health care team,using communication skills,to ensure the accurate transfer of key information.

Objective:To explore the evaluation and demand of clinical medical postgraduates for the supervisors' ethics and morality, and to explore ways to construct their ethics and morality in medical education.Methods:In the study, 2 268 clinical medical postgraduates in a medical university in Jiangsu Province were investigated with their satisfaction, compliance and suggestions. Rank sum test was carried out for the satisfaction by using SPSS 26.0, and qualitative analysis was carried out for suggestions.Results:The overall satisfaction of graduate students to the ethics and morality of supervisors was high. All the items described in the supervisors' ethics were "very consistent" more than 80%. Through qualitative analysis, the feedback were divided into six themes namely "supervision and feedback", "supervisor training", "reward and punishment system", "communication", "caring for students" and "academic guidance".Conclusion:The evaluation of clinical medical supervisors' ethics and morality is generally at a high level. The cultivation and guidance of supervisors' ethics and morality, supervision mechanism, and reward and punishment system still need to be improved.

BACKGROUND:Vertebral compression fracture is a common disease in the current orthopedic field.However,the occurrence of re-fracture in neighboring vertebrae after surgery is a problem that cannot be ignored,which has a serious impact on the normal life of patients. OBJECTIVE:The aim of this study is to establish four postoperative models with different recovery heights using computed tomography images.By using finite element analysis,we derived the stresses on the neighboring vertebrae at different recovery heights and further explored the importance of postoperative recovery of the height of the injured vertebrae. METHODS:A finite element model of the thoracolumbar spine(T11-L3)was established and validated,on the basis of which four postoperative finite element models of L1 with different recovery heights of 100%,80%,60%,and 40%were constructed,in which the cement capacity varied with the recovery height.The specific models are as follows:Model 1 was the postoperative model with normal recovery height,and the cement capacity was 8.3 mL.Model 2 was the postoperative model in which 20%of the anterior height of the L1 was removed and the posterior convexity angle became 10.41°,and the cement capacity was 6.9 mL.Model 3 was the postoperative model in which 40%of the anterior height of the L1 was removed and the posterior convexity angle became 20.17°,and the cement capacity was 4.7 mL.Model 4 was a postoperative model with 60%of the L1 anterior height removed and the posterior convexity angle changed to 28.85°,with a cement capacity of 3.6 mL.For evaluation of the postoperative model,we applied a moment of 7 Nm and an axial force of 500 N.The followings were recorded and analyzed:peak stresses in the L2 upper endplate and T12 lower endplate;peak stresses in the L2 and T12 cancellous bone. RESULTS AND CONCLUSION:(1)The highest peak stresses for each condition of the L2 upper endplate,T12 lower endplate,L2 cancellous bone,and T12 cancellous bone occurred in Model 1 and Model 4.In particular,the T12 lower endplate,except for the posterior extension condition,the anterior flexion,left and right lateral bending,and left and right rotation conditions all reached their highest peak stresses in Model 4,with stresses of 50.3,33.1,44.9,34.3,and 31.9 MPa.(2)Based on the peak stresses in the adjacent vertebral endplates and cancellous bone,after excluding Model 1 and Model 4,the minimum peak stresses for most of the conditions appeared in the Model 2,and the minimum peak stresses appeared in the Model 2 in 66.6%of the cases,especially in the upper endplates of the L2 and cancellous bone except for the posterior extension condition,the minimum peak stresses all appeared on the Model 2.(3)Therefore,controlling the recovery height at about 100%and 40%of the original height was a dangerous recovery height,which had a greater impact on the neighboring vertebrae.Controlling the recovery height at about 80%of the original height may be a more ideal choice.With a recovery height of about 80%of the original height,the adjacent vertebrae are subjected to less stress,thus reducing the risk of re-fracture of the adjacent vertebrae in the patient.

Objective:To observe the relationship between inducible carbon monoxide synthase (iNOS) and delayed encephalopathy after acute carbon monoxide poisoning (DEACMP), and explore its mechanism of action in DEACMP.Methods:This study was designed as prospective cohort study. Patients with acute carbon monoxide poisoning who met the diagnostic criteria and were admitted to Emergency Intensive Care Unit(EICU) of our hospital from June 2019 to June 2021 were selected as subjects. Patients were divided into the DEACMP group and non-DEACMP group according to the occurrence of DEACMP. Serum samples were collected on the first 24 h after admission and on day 7 and 14 after admission, and the serum nitric oxide (NO), neuronal nitric oxide synthase (nNOS), inducible carbon monoxide synthase (iNOS), and endothelial nitric oxide synthase (eNOS) level were measured by enzyme-linked immunosorbent assay. The generalized estimating equation was used to estimate the difference of NO, nNOS, iNOS and eNOS between DEACMP and non-DEACMP patients.Results:A total of 78 patients with carbon monoxide poisoning were included in our study finally, including 49 (62.82%) males and 29 (37.18%) females, with an average age of (53.96±14.95) years, 20 (25.64%) patients with DEACMP, and 1 (1.28%) death. Univariate analysis showed that patients with DEACMP had an average increase of 3 h (95% CI: 1.00, 5.00) in carbon monoxide exposure time and a 5-point decrease in GCS score (95% CI: 1.00, 6.00) than the patients without DEACMP, and the proportion of patients with severe carbon monoxide poisoning in the DEACMP group was higher than that of the non-DEACMP group (90.00% vs. 32.76%). According to the analysis of generalized estimation equation, on day 7 and 14 after admission, Compared with non-DEACMP patients, neither by performing unadjusted nor adjusted analysis with the iNOS of DEACMP patients was significantly higher than that in non-DEACMP patients regardless of whether exposure time, GCS score, coma time or severity of carbon monoxide poisoning were adjusted or not ( P <0.01 or P <0.05). Except for the level of nNOS in the GEE model adjusted with carbon monoxide exposure time, the levels of NO, nNOS and eNOS showed no significant difference between DEACMP and non-DEACMP patients ( P >0.05). Conclusions:The expression of iNOS level is increased in DEACMP patients, and its continuous expression may be involved in the pathogenesis of DEACMP.

BACKGROUND:The elastic modulus of traditional bone implants is large and does not match the elastic modulus of human bone,which will cause a stress shielding effect and lead to bone resorption.The trabecular scaffold of the triply periodic minimal surface with radial gradient has elastic modulus matching with human cancellous bone,and its yield strength is greater than that of human cortical bone,which provides a new choice for the design of bone scaffold. OBJECTIVE:Triply periodic minimal surface structure with radial gradient was constructed by the implicit surface method.The sample was manufactured by laser selective melting technology,and the quasi-static compression test was carried out to obtain trabecular scaffolds with mechanical properties matching human bones. METHODS:Four types of the trabecular scaffolds of the triply periodic minimal surface with a radial gradient of G,I,P and D were established by the implicit surface method.Samples were manufactured by laser selective melting technology.We observed the surface morphology of the molded sample,evaluated the molding quality,conducted a quasi-static compression test,and evaluated the mechanical properties of the samples. RESULTS AND CONCLUSION:The quasi-static compression test results showed that compared with the four triply periodic minimal surface scaffolds,the platform stress of the G scaffold had less fluctuation and no failure or fracture,indicating that the G scaffold had the best plasticity.The mechanical properties of the G scaffolds with 45%,55%and 65%porosities were analyzed.It was found that the elastic modulus of G scaffolds with 55%porosity was within the range of elastic modulus of human cancellous bone(0.022-3.7 GPa),and the yield strength was close to the maximum yield strength of human cortical bone(187.7-222.3 MPa).In conclusion,G triply periodic minimal surface scaffold with 55%porosity can reduce the stress shielding effect,bear a higher body load,improve the stability of the implant,and prolong the service life of the implant.

Objective: To investigate the effect of incisor retraction on three-dimensional morphology of upper airway and fluid dynamics in class Ⅰ adult patients with bimaxillary protrusion. Methods: Thirty class Ⅰ patients with bimaxillary protrusion that received fixed orthodontic treatment in Department of Stomatology, The First Affiliated Hospital of Wenzhou Medical University from January 2011 to September 2014 were selected using random number table. All the patients were treated with extraction of four first premolars and retraction of anterior teeth using implant anchorage. Cone-beam CT (CBCT) scans were performed before and after incisor retraction for all patients. The CBCT data of the upper airway were constructed using Mimics 16.0, and the flow field characteristics inside the upper airway were simulated using Ansys 14.0. The changes of volume (V), mean cross-sectional area (mCSA), maximum lateral diameters/maximum anteroposterior diameters (LP/AP) of cross section, the maximum pressure of airflow (P_max), the minimum pressure of airflow (P_min) and pressure drop (△P) of nasopharynx, oropharynx and hypopharynx before and after incisor retraction were measured and compared using paired t test. The correlation between the variation of △P in the most significant pharyngeal part and the morphological variables after incisor retraction was analyzed using Pearson correlation test. Results: No statistical differences were observed in the morphology and flow field in nasopharynx before and after incisor retraction (P>0.05). Before incisor retraction, the oropharyngeal volume and mCSA were (7 580±622) mm³ and (217±40) mm², respectively, and the hypopharyngeal volume and mCSA were (2 564±162) mm³, and (239±43) mm², respectively. After incisor retraction, the volumes of oropharynx and hypopharynx were (6 885±601) mm³ and (2 535±156) mm³, respectively, and mCSA of oropharynx and hypopharynx were (197±37) mm² and (236±42) mm², respectively. The volume and mCSA of oropharynx and hypopharynx were significantly decreased after incisor retraction (P<0.05). The greatest changes in pharyngeal volume and mCSA occurred in the oropharynx. In addition, the LP/AP of oropharynx after incisor retraction was changed from 1.9±0.6 to 2.1±0.7, which was significantly increased compared with the levels before incisor retraction (P<0.05). After simulation of pharyngeal airflow, the oropharyngeal P_min, hypopharyngeal P_max and P_min were (-13.7±4.3), (-8.3±3.8) and (-42.8±9.5) Pa, respectively, whereas the values turned to (-16.4±6.5), (-11.9±3.6) and (-46.0±11.0) Pa, respectively after incisor retraction, which was significantly reduced (P<0.05). △P of oropharynx was significantly increased from (42.7±10.1) Pa to (45.2±13.0) Pa after incisor retraction (P<0.05) and the variation of oropharyngeal △P was negatively correlated with the variation of V and mCSA in oropharynx before and after incisor retraction (r=-0.681, P=0.001; r=-0.844, P=0.000). Conclusions The oropharynx was constricted and the pharyngeal resistance was increased after incisor retraction in adult class Ⅰ patients with bimaxillary protrusion. A comprehensive and systematic evaluation of the pharyngeal morphology and ventilatory function were very important for making a scientific and rational clinical treatment plan.